Generalism has been overshadowed for the past two decades by the rapid rise of evidence based medicine, which has brought great benefits to patients all over the world and has become a major policy driver. However, there is a growing recognition that a generalist approach is, in many clinical situations, essential for the proper application of the evidence to the individual patient.
The generalist approach means that GPs have a broad range of clinical skills alongside a detailed knowledge of the family and community of the patient. This will be increasingly important as our population continues to age and we see an increase in the numbers of elderly (and sometimes not so elderly) people with several co-morbidities such as heart disease, diabetes, depression and arthritis.
Here in Scotland, in the most deprived areas described in the Deep End project, (a project which brings together GPs from the 100 most deprived general practices in Scotland) multi-morbidity is often the norm rather than the exception.
As well as the common chronic diseases, drug and alcohol misuse, smoking related illness and mental health problems add great complexity and often misery to people’s lives and the GP’s work. We believe that policy solutions which put general practice at the hub offer the most suitable and cost effective method of tackling these major problems from the heart of the community.
Seeking to explore and define generalism further in light of this pressing need is the recently established RCGP Commission on Generalism, which Clare Gerada described as 'one of the most important pieces of work that the College has ever carried out and has the potential to inform and influence healthcare policy for years to come'. The Commission aims to:
- Agree a definition for generalis.
- Instigate a structured discussion of the rationale for, and the current status of, medical generalism.
- Make an analysis of the effectiveness of, and any problems associated with, generalist practice.
- Make recommendations for the future direction of the generalist role, with reference to workforce planning.
General Practice can make a greater contribution to the wider NHS in Scotland, perhaps especially in developing Community Health Partnerships, but also in ensuring that the Quality agenda is effectively led and delivered in primary care. The generalist perspective means that our viewpoint is not limited to a disease-focused model; we are able to be human beings first and doctors second, and integrate the biotechnical and biographical approaches in the interests of both individual patients and the NHS.
The Commission on Generalism’s regional listening events will be held in autumn 2011.
Dr John Gillies is Chairman of RCGP Scotland